Assessment of Perfusion Reserve and Effects of Exercise in Microvascular Angina

描述（由申请人提供）：项目概述：本提案的目的是培养Jamieson Bourque，M.D.的临床研究技能和科学发展，M.H.S.，帮助他成为一名独立的临床研究者Bourque博士的培训目标是接受足够的临床研究培训，以成功地获得批准人发起的R 01资金。弗吉尼亚大学是进行创新研究的理想场所，涉及微血管功能障碍的非侵入性评估以及运动疗法在该疾病过程中的应用，这是由于教师在心肌梗塞和运动疗法方面的强大研究和临床专业知识以及强大的机构对Bourque博士的承诺。他的主要导师，医学博士克里斯托弗克雷默，是一个国际上受人尊敬的思想领袖，在应用心脏磁共振成像评估微血管功能。他有一个长期证明的指导记录。重要的是，Bourque博士的职业发展计划包括血管生物学，高级运动生理学，图像采集和处理，生物统计学和研究伦理学的高级课程，这将加强他的能力，以追求他的长期目标，即发展微血管功能障碍的非侵入性评估和运动疗法的应用以及以患者为中心的结果临床研究这种病态疾病的过程。伯克博士的研究问题对公共卫生至关重要。心绞痛是一种高度病态的疾病，但阻塞性冠状动脉疾病（CAD）见于<50%的病例。这些患者可能患有微血管功能障碍，可以通过心脏磁共振成像（CMR）无创评估。对这一病态人群的最佳治疗尚未进行充分研究。多种药物和治疗性运动可改善微血管功能、有氧能力和结局，包括心绞痛症状、生活质量和心脏事件。Bourque博士建议的具体目的是：1）确定心绞痛和无阻塞性CAD患者心肌灌注储备降低和以患者为中心的结局的预测因素; 2）比较心绞痛和无阻塞性CAD患者强化药物治疗与强化药物治疗加运动之间心肌灌注储备、有氧能力和以患者为中心的结局的变化。为了实现这些目标，Bourque博士将对有心绞痛症状且冠状动脉造影无阻塞性疾病的患者进行前瞻性研究，这些患者将接受临床评估，然后进行CMR灌注成像。灌注储备降低的患者将随机接受药物治疗与药物治疗+运动，并评估灌注储备、有氧能力和以患者为中心的结局的变化。这个研究项目的宝贵培训，强大的指导和教学计划将大大有助于Bourque博士实现成为独立临床研究者的目标。

DESCRIPTION (provided by applicant): Project Summary: The purpose of this proposal is to foster the clinical research skills and scientific development of Jamieson Bourque, M.D., M.H.S., to facilitate his transition to an independent clinical investigator. Dr. Bourque's training goal i to receive sufficient clinical research training to successfully pursue investigator-initiated R01 funding. The University of Virginia is an ideal venue to perform innovative research involving the noninvasive assessment of microvascular dysfunction and the application of exercise therapy to this disease process due to the strong research and clinical expertise of faculty in both CMR and exercise therapy and the strong institutional commitment to Dr. Bourque. His primary mentor, Christopher Kramer, M.D., is an internationally- respected thought leader in the application of cardiac magnetic resonance imaging to assess microvascular function. He has a long proven mentorship track record. Importantly, Dr. Bourque's career development plan includes advanced classes in vascular biology, advanced exercise physiology, image acquisition and processing, biostatistics, and research ethics that will strengthen his ability to pursue his long-term goal of developing a specialization in the noninvasive assessment of microvascular dysfunction and the application of exercise therapy and patient-centered outcomes clinical research to this morbid disease process. Dr. Bourque's research question is of paramount public health importance. Angina is a highly morbid condition but obstructive coronary artery disease (CAD) is seen in <50% of cases. These patients may have microvascular dysfunction, which can be assessed noninvasively by cardiac magnetic resonance imaging (CMR). The optimal treatment of this morbid population has not been sufficiently studied. Multiple medications and therapeutic exercise may improve microvascular function, aerobic capacity, and outcomes including anginal symptoms, quality of life, and cardiac events in this highly prevalent patient population. The specific aims of Dr. Bourque's proposal are: 1) to determine the predictors of reduced myocardial perfusion reserve and patient- centered outcomes in patients with angina and no obstructive CAD; and 2) to compare changes in myocardial perfusion reserve, aerobic capacity, and patient centered outcomes between intensive medical therapy and intensive medical therapy plus exercise in patients with angina and no obstructive CAD. To address these aims, Dr. Bourque will perform a prospective study of patients with anginal symptoms and no obstructive disease on coronary angiography, who will undergo a clinical assessment followed by CMR perfusion imaging. Those with reduced perfusion reserve will be randomized to medical therapy versus medical therapy + exercise and changes in perfusion reserve, aerobic capacity, and patient-centered outcomes will be assessed. The invaluable training from this research project, robust mentorship, and didactic program will greatly assist Dr. Bourque in fulfilling his goal of becoming an independent clinical investigator.